Effect of Antiretroviral Therapy in Human Immunodeficiency Virus-infected Children (original) (raw)
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Clinical Infectious Diseases, 2003
We assessed the risk of acquired immunodeficiency syndrome (AIDS)-related opportunistic illness or death among persons first prescribed highly active antiretroviral therapy (HAART) in January 1996 or later in the Centers for Disease Control and Prevention's Adult and Adolescent HIV Spectrum of Disease Project. Patients were included if they were naive to antiretroviral drugs and had no history of AIDS-related opportunistic illness. Risk was assessed as a function of CD4 + lymphocyte count and human immunodeficiency virus load at the time of initiation of HAART in a Cox proportional hazards model. Hazard ratios for AIDS or death were 6.3, 3.5, and 1.7 for persons with baseline CD4 + cell counts of 0-49, 50-199, and 200-349 cells/mL, respectively, compared with the referent (CD4 + cell count у500 cells/mL). HAART should not be deferred until the CD4 + cell count reaches !200 cells/mL. The increased hazard associated with CD4 + cell counts of 200-349 cells/mL was modest but supports initiation of HAART at CD4 + cell counts !350 cells/mL, particularly in patients with high virus loads.
The Pediatric Infectious Disease Journal, 2009
Background: Non-nucleoside reverse transcription inhibitor (NNRTI)based highly active antiretroviral therapy (HAART) is the recommended first-line regimen for children in Thailand. This study was aimed to assess pattern and predictors of immune recovery in antiretroviral-naive Thai children starting NNRTI-based HAART. Methods: Records were extracted from clinical databases of 2 treatment cohorts in Thailand. The inclusion criteria were HIV-infected naive children who initiated NNRTI-based HAART when CD4 Ͻ25%. Immune recovery was defined as achieving a target CD4% of 25. The impact of age, gender, baseline clinical category, CD4 and HIV RNA titer, and regimen on immune recovery to weeks 96 was assessed using multiple logistic regression. Results: There were 274 patients (52% females) with a median baseline age of 7 (Interquartile range ͓IQR͔: 4-9) years and a median CD4% of 5 (IQR: 1-12) who started treatment with nevirapine (66%) or efavirenz (34%) based HAART. Median duration of follow-up was 168 (IQR: 120-192) weeks. The median CD4% increase from baseline was 7% (IQR: 5-11) and 18% (IQR: 12-23) at weeks 24 and 96, respectively. The probability of reaching target CD4% was 51% (95% confidence interval: 45%-57%) by week 96. The predictors of immune recovery at week 96 were younger age, female gender, higher baseline CD4%, and sustained virologic suppression after week 24. Conclusion: In this cohort of children with low baseline CD4, half achieved immune recovery after 96 weeks of HAART. The predictors for immune recovery are younger children, female gender, high baseline CD4%, and long-term virologic suppression.
Clinical Infectious Diseases, 2003
An observational study was performed involving 95 children with vertically transmitted human immunodeficiency virus type 1 infection to assess the sustainability of undetectable viral loads (VLs) and increased CD4 + T lymphocyte percentages after 48 months of highly active antiretroviral therapy (HAART). The median time to achieve a 10% increase in the CD4 + T lymphocyte percentage was 11.01 months. The median time to achieve an undetectable VL was 6.4 months. At the end of the study, 64.2% of the children had achieved an undetectable VL. Of the patients with an initial VL of 13.6 log 10 copies/mL, 74.7% had a decrease in the VL of 1 log 10 copies/mL. By contrast, of the patients who presented with an initial VL of 14.6 log 10 copies/mL, 37.9% had a decrease of 12 log 10 copies/mL. Higher VL at baseline, antiretroviral therapy regimens received before HAART, and multiple drug switches while receiving antiretroviral therapy were all inversely associated with an undetectable VL. A CD4 + T lymphocyte percentage of 125% was directly associated with undetectable VL during the follow-up period. In conclusion, first-line HAART induces beneficial virological and immunological outcome responses in children.
2005
Background. The goal of the present study was to characterize outcome and predictors of outcome of treatment interruption (TI) in highly active antiretroviral therapy (HAART)-treated patients. Methods. A systematic chart/database review was conducted to identify patients with nadir CD4 cell counts 1200 cells/mm 3 and without acquired immunodeficiency syndrome-defining illnesses who underwent a TI. Collected data included duration and reason for TI, demographic characteristics, CD4 cell count, and plasma viral load. Human immunodeficiency virus (HIV) envelope (V3) loop genotyping was performed on plasma HIV RNA. The presence of basic residues at aa 11 and/or 25 (the "11/25" genotype) was a further possible prognostic variable of interest. Cox proportional hazards models were used to assess characteristics associated with time to HAART reinitiation after TI. Results. A total of 208 of 4461 (4.7%) patients underwent TI. The study group consisted of 197 (94.7%) of 208 participants for whom V3 genotyping was successful. The median CD4 cell count at time of the initiation of TI was 620 cells/mm 3. A total of 59 (29.9%) patients reinitiated HAART after a median of 15 months. At the time of the reinitiation of HAART, the median plasma viral load was 1100,000 copies/mL, and the median CD4 cell count was 260 cells/mm 3. Among the 197 study patients, there were 6 deaths, none of which was attributable to the TI. A total of 81% had plasma viral loads !50 copies/mL by 15 months of follow-up after reinitiation of HAART. In multivariate analysis, a nadir CD4 cell count р250 cells/mm 3 (risk ratio [RR], 2.79 [95% confidence interval {CI}, 1.60-4.86];) and the presence of the 11/25 genotype (RR, 2.07 [95% CI, 1.07-4.02]; P ! .001 P p) were positively and independently associated with faster time to HAART reinitiation, after adjusting for age .031 and plasma virus load at the start of TI. Conclusions. Our study suggests that TI is a viable option for HIV-positive adults with nadir CD4 cell counts 1250 cells/mm 3. A nadir CD4 cell count of 200-250 cells/mm 3 and the 11/25 viral genotype were found to be associated with a faster HAART reinitiation. Highly active antiretroviral therapy (HAART) has resulted in improved quality of life and has increased
Clinical Infectious Diseases, 2006
Several studies of children with human immunodeficiency virus (HIV) type 1 infection have demonstrated sustained increases in CD4 + cell count, even when virological failure has occurred after receipt of highly active antiretroviral therapy (HAART), but these studies were of limited duration. Moreover, the CD4 + cell count threshold at which antiretroviral treatment should be initiated is still unsettled. The aim of this study was to define the long-term impact of HAART on CD4 + cell percentage and viral load according to CD4 + cell percentages before HAART was initiated.
When to Initiate Highly Active Antiretroviral Therapy: A Cohort Approach
American Journal of Epidemiology, 2003
The appropriate immunologic stage of human immunodeficiency virus infection at which to initiate highly active antiretroviral therapy (HAART) among asymptomatic persons is a core question. A cohort approach using longitudinal data from the US Multicenter AIDS Cohort Study was used to mimic a clinical trial to assess the risk of acquired immunodeficiency syndrome (AIDS) by timing of therapy. Three treatment groups were defined according to CD4 + count (cells/µl) at HAART initiation between July 1995 and January 2000: <200 (deferral to <200, n = 127), 200-349 (deferral to 200-349, n = 130), and 350-499 (immediate treatment, n = 92). Survival analysis was used to compare time to AIDS between groups from the index visit until July 2000. The index visit for the immediate group was the one prior to HAART initiation. For the deferral groups, the index visit was a randomly selected, pre-HAART, AIDS-free visit after July 1990 at which CD4 + counts were 350-499 cells/µl. This strategy accounted for lead time bias. Compared with immediate treatment, the relative hazards of AIDS were 2.68 (p = 0.003) and 1.05 (p = 0.897) for deferral to <200 cells/µl and 200-349 cells/µl, respectively. These results support recent US public health guidelines for deferring HAART initiation until a count of <350 cells/µl. Furthermore, results suggest a potential threshold for HAART initiation in the neighborhood of 275 cells/µl. cohort studies; epidemiologic methods; HIV Abbreviations: AIDS, acquired immunodeficiency syndrome; CI, confidence interval; D <200, deferred treatment group of men whose CD4 + counts were <200 cells/µl; D <350, deferred treatment group of men whose CD4 + counts were 200-349 cells/µl; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus.
Revista clínica española, 2007
The use of HAART combining 2 nucleoside analogues reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor (PI) or 2 NRTIs + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) has shown comparable efficacy. The study was designed to compare long term (2 years) effectiveness of two antiretroviral (ARV) treatment strategies in patients not previously treated: starting with a nelfinavir based HAART switching to nevirapine in case of failure or side effects or the reverse sequence. This multicenter, randomized, open label clinical trial enrolled ARV-naïve HIV patients with CD4 counts below 500 cells/mm3. They were randomly assigned to start ddI + d4T + nelfinavir (switching to ZDV + 3TC + NEV in case of failure or toxicity) (PI-NEV arm) or ddI + d4T + nevirapine, switching to ZDV + 3TC + NFV in case of failure or toxicity (NEV-PI arm). The primary study endpoint was the Kaplan-Meier estimates of the time to failure after switching to second regimen if necessary (consid...